Journal of critical care
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Human errors are the most common reason for planes to crash, and of all human errors, suboptimal communication is the number 1 issue. Mounting evidence suggests the same for errors during short-term medical care. Strong verbal communication skills are key whether for establishing a shared mental model, coordinating tasks, centralizing the flow of information, or stabilizing emotions. ⋯ Therefore, this article offers practical strategies borrowed from aviation and applied to critical care medicine. These crisis communication strategies include "flying by voice," the need to combat "mitigating language," the uses of "graded assertiveness" and "5-step advocacy," and the potential role of Situation, Background, Assessment, and Recommendation communication. We also outline the "step-back method," the concept of communication "below ten thousand feet," the impetus behind "closed-loop communication," and the closely related "repeat-back method." The goal is for critical care practitioners to develop a "verbal dexterity" to match their procedural dexterity and factual expertise.
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Journal of critical care · Apr 2011
Toward less sedation in the intensive care unit: a prospective observational study.
Excessive sedation is associated with prolonged mechanical ventilation and longer intensive care unit (ICU) and hospital stays. We evaluated the feasibility of using minimal sedation in the ICU. ⋯ In a mixed medical-surgical ICU, minimal use of continuous sedation seems feasible without apparent adverse effects.
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Journal of critical care · Apr 2011
Diazepam as a component of goal-directed sedation in critically ill trauma patients.
Limited information addressing the safety and efficacy of diazepam in the intensive care unit, particularly in trauma patients, is available. The purpose of this study is to evaluate the safety and efficacy of diazepam when used in routine clinical practice as a component of a goal-directed sedation regimen in critically ill trauma patients. ⋯ Based on this limited sample, the use of diazepam as a component of goal-directed therapy appears safe and effective in providing adequate sedation in critically ill trauma patients using an average dosage of 40 mg/d.
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Journal of critical care · Apr 2011
Intraoperative adherence to a low tidal volume ventilation strategy in critically ill patients with preexisting acute lung injury.
Low tidal volume (LTV) ventilation reduces mortality in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). This study investigates adherence of intraoperative LTV and whether patient outcomes were different with or without continued intraoperative LTV ventilation in patients with previously established ALI or ARDS. ⋯ Adherence to intraoperative LTV in surgical patients was low. Adherence of LTV intraoperatively was not associated with improved oxygenation, reductions in hospital length of stay, or in-hospital mortality. The importance of adhering to an intraoperative LTV strategy remains unclear.
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Journal of critical care · Apr 2011
Validation of the Intensive Care Delirium Screening Checklist in nonintubated intensive care unit patients in a resource-poor medical intensive care setting in South India.
Delirium is a common, difficult-to-diagnose clinical condition in critical care units. The lack of recognition of delirium often results in increased morbidity and mortality. The study aimed to determine the validity and reliability of the Intensive Care Delirium Screening Checklist (ICDSC) in a resource-poor medical intensive care setting in South India. ⋯ Our findings indicate that in nonintubated intensive care unit patients, the ICDSC can be used to screen for delirium but should not be used as a diagnostic instrument in this patient population and that residents can be trained in the use of the instrument in resource-poor critical care settings. Using a different threshold for positivity of 3 rather than 4 appeared to offer improved screening characteristics in this resource-poor critical care setting.